ABSTRACT
Objective To summarize the experience of perioperative treatment of lung transplantation for end-stage lung disease. Methods Perioperative clinical data of 7 recipients undergoing lung transplantation were retrospectively analyzed, including 3 cases with bilateral lung transplantation and 4 cases with unilateral lung transplantation. The perioperative status and clinical prognosis of lung transplantation recipients were observed. Results The operation time of 7 lung transplantation recipients was (344±133) min. Cold ischemia time was (236±74) min in 4 cases of single-lung transplantation and (480±120) min in 3 cases of bilateral-lung transplantation. The length of Intensive care unit(ICU) stay was 21 (13-25) d and the length of hospital stay was 101 (64-117) d. In the first 3 d after surgery, the daily fluid output was significantly larger than the fluid input (all P < 0.05). The arterial oxygen partial pressure (PaO2) of lung transplantation recipients in the first 3 d after surgery was significantly elevated than preoperative level (all P < 0.05), whereas the arterial carbon dioxide pressure (PaCO2) did not significantly change (all P > 0.05). All recipients had pulmonary bacterial infection after lung transplantation, including 3 cases complicated with fungal infection. One recipient underwent exploratory thoracotomy for hemostasis due to active thoracic bleeding after operation, 1 recipient suffered from primary graft dysfunction (PGD) and 4 recipients received secondary endotracheal intubation. Two cases died after operation, 1 case died of septicemia caused by multidrug-resistant acinetobacter baumannii, the other case died of rejection reaction after self-terminating use of immunosuppressive agents. The remaining 5 cases were successfully discharged and recovered well. The longest survival period was 3.1 years. Conclusions In the perioperative management of lung transplantation, it has great significance to hold the surgical indications, monitor and manage postoperative refined fluid and hemodynamics, implement the strategy of protective pulmonary ventilation, and early diagnose and treat severe postoperative complications for the recipients of lung transplantation to safety through the perioperative period.
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Objective:To analyze the main inputs and outputs of China's health reform,to propose suggestion on improving health policy.Methods:Using health economics input and output analysis methods.Results:From 2009 to 2016,more than 50％ of Chinese health personnel were distributed in the hospital and increased by year,more than 70％ of the government's main health expenditure were paid for disease treatment,the total number of new patients was 2.44 billion,and the number of inpatients was 100 million.The actual medical burden of individual residents in China was 49.36％ in 2016.The prevalence of chronic diseases among residents increased by 9％ from 2008 to 2013.Conclusion:China should put more new health investment and resources into disease prevention and control,so as to improve the health level and health input and output performance of residents.
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Objective:To obtain the health production efficiency performance and its changing trend of China's health system in recent years by adopting international comparison,and to provide policy recommendations to improve health production efficiency.Methods:It described the relative efficiency of health system in China by reporting the international ranking of health inputs and outputs indicators.It employed total health expenditure per capita as input indicator and health outcomes as output indicators to construct frontier health production function,China's health production function and marginal health production function based on data envelopment analysis and production function method.Results:In the past decade,compared to efficient countries with similar health development level,the efficiency performance of China's health system was between 65％ and 73％.With the increasing trend of health investment,China's marginal health output had been declined and tended to be gentle.Conclusion:The current health production efficiency in China was relatively high.However,how to improve the efficiency and marginal health output was the focus of future health system reform under the background of rapid growth of total health expenditure.
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Objective: To study the input and output efficiency of the general hospitals based on the sampling data, in order to infer the operational efficiency of the general hospital in Hubei Province. Methods: Cobb-Douglas production function is extended and the input-output efficiency of 50 hospitals is analyzed by Data Exchange Agreement ( DEA). Results: Based on C-D production function expansion, through the sampling survey of input and output data, screening the input and output indicators of general hospitals, use DEA to conclude the put-output efficiency of 50 general hospitals in Hubei. Conclusion: The bed utilization rate of 50 general hospitals is low, the general hospital beds should be appropriately reduced, and corresponding policy recommendations are proposed.